As changes in food habits and stress take a heavy toll on human health, irritable bowel syndrome (IBS) has emerged as one of the most prevalent gastrointestinal disorders in the country. IBS is a chronic condition of the digestive system affecting around 15 per cent of the global population and is second only to the common cold as a reason for absence from work. The condition often begins in young adulthood, with women twice as likely as men to be diagnosed with it.
Around 7-8 per cent of the Indian population suffers from IBS and accounts for 25-50 per cent of all gastrointestinal referral patients, as the condition is fairly common in the community. Although the symptoms may vary over time, the condition is often life-long. It is usually benign and accounts for significant global morbidity and poor quality of health.
The gastrointestinal disorders that affect the large intestine comprise a group of symptoms that can vary in severity and duration. Sometimes the symptoms are so strong that they can significantly affect everyday lives causing distress. Despite the high prevalence of irritable bowel syndrome in the global population, the mechanisms responsible for this condition are poorly understood.
“Microbes in the human gastrointestinal tract are responsible for the maintenance and structural integrity of gastrointestinal mucosal barrier, immunomodulation, metabolism of nutrients and protection against pathogens,” said Dr Hemanta Kumar Nayak, additional professor, gastroenterology department, AIIMS, Bhubaneswar.
“Dysfunctions in these mechanisms are linked to a range of conditions, ranging from IBS to functional constipation and functional diarrhoea. It has been estimated that up to a third of patients with functional gastrointestinal disorders have features of more than one, suggesting a common underlying etiology,” he said.
Causes and symptoms
Though the exact cause of IBS is not known, there are several factors like muscle contractions in the intestine, issues with the nervous system, early life stress and changes in gut microbes play a significant role. Factors that can increase one’s chance of having IBS include bad food habits, having a family member with IBS, a history of stressful or difficult life events, such as abuse during childhood. “Like human behaviour, which is unpredictable, bowels too can get irritated and become uncomfortable. The aetiology of gastrointestinal disorders may be unknown as it is linked to multiple factors. Food habits play a role, apart from stress events and anxiety that affect the physical and mental health and also triggers IBS,” said Dr SL Broor, senior consultant (gastroenterology), Indraprastha Apollo Hospitals, Delhi.
Symptoms include cramping, abdominal pain, nausea, gas formation, bloating of the abdomen, poor appetite, weight loss, fatigue, stool with blood/mucus, diarrhoea, and constipation. IBS is a chronic condition that an individual has to manage for the long term.
“Anxiety and depression have a notable impact on the communication between the brain and the gut. A stressed brain can disrupt gut function since these two systems are closely interconnected. The majority of IBS cases are linked to food intolerance or sensitivity, where specific foods can trigger digestive symptoms, such as lactose and gluten intolerance,” said Dr Harish Kareem, senior consultant, gastroenterology department, KIMS-Health, Thiruvananthapuram. There are three subtypes of irritable bowel syndrome - diarrhoea-predominant, constipation-predominant, and mixed having both diarrhoea and constipation symptoms intermittently.
Diagnosis
Even as there is no definite test to diagnose irritable bowel syndrome, most of the cases can be diagnosed clinically with a complete medical history and physical examination. Few tests can be done to rule out other conditions, such as colon cancer, celiac disease and inflammatory bowel disease.
“Rome criteria is used to diagnose IBS. The criteria include belly pain and discomfort averaging at least one day a week in the last three months. This must also occur with at least two of the symptoms - pain and discomfort related to defecation, a change in the frequency of defecation, or a change in stool consistency,” said Dr Ayaskanta Singh, senior consultant at SUM Ultimate Medicare.
People having more severe symptoms must be evaluated for weight loss, rectal bleeding, fever, nausea or recurrent vomiting, belly pain, especially if it is not related to a bowel movement or occurs at night, diarrhoea or interrupted sleep and anaemia related to low iron. Diagnostic procedures can include colonoscopy, CT scan and upper endoscopy along with laboratory tests for lactose intolerance, breath test for bacterial overgrowth and stool tests.
Treatment and management
Treatment of IBS focuses on relieving symptoms so that you can live as symptom-free as possible. With the right strategies, IBS can be successfully managed. A number of natural therapies have been used for treating IBS. It is possible to relieve symptoms of this condition through antispasmodics. Some people find relief by taking probiotics to improve gut bacterial flora.
“Stress management techniques and therapies like cognitive-behavioural therapy (CBT) can be beneficial. Mild symptoms can often be controlled by managing stress and by making changes in diet and lifestyle,” said Dr Nayak. People suffering from IBS must avoid food that triggers symptoms and should eat food with high-fibre content, drink plenty of fluids, exercise regularly and get enough sleep. Foods to avoid include high-gas foods, gluten and fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAPs).
If someone experiences bloating or gas, they should avoid items such as carbonated and alcoholic beverages and certain foods that may lead to increased gas. “Some people with IBS report improvement in diarrhoea symptoms if they stop eating food with gluten – naturally found in wheat, barley and rye - even if they don’t have celiac disease. People sensitive to certain carbohydrates found in certain grains, vegetables, fruits and dairy products should avoid these foods,” said Dr Singh. Lifestyle correction, yoga, meditation, exercise and diet alterations play significant roles in managing the disorder. Usually cutting down on dairy, wheat, nuts, corn, peas, rajma, egg whites and fermented foods works wonders.
Preventive Measures
One of the first lines of defence is to start a gluten-free diet and avoid processed food which contains hidden ingredients to prevent intestinal disorders. Gluten is a protein that can cause irritation and illness in those who are sensitive to it, or those who have celiac disease. Management of irritable bowel syndrome is different for everyone as it depends on how one’s body reacts to common symptom triggers and learning to prevent them. People must avoid the unregulated use of drugs that can lead to osteoporosis and impact the kidneys.
Physical exercise or yoga to manage stress and anxiety is a must to prevent IBS. Engage yourself in daily regular physical activity to help regulate bowel function and drink plenty of water to maintain healthy digestion. Limit alcohol and caffeine to prevent irritation in the digestive system.
“If you suspect you have IBS or experiencing persistent gastrointestinal symptoms, seek medical advice to rule out any other organic disease by proper investigation. Consulting a healthcare professional is crucial to develop an effective treatment plan tailored to individual needs,” Dr Nayak added.
Irritable bowel syndrome (IBS) is a common disorder that affects the stomach and intestines, also called the gastrointestinal tract
Syndrome
Only a small number of people with IBS have severe symptoms. Some can be controlled by managing diet, lifestyle and stress, while more severe symptoms can be treated with medication and counselling. Symptoms vary but are usually present for a long time. The most common include:
Causes
Although the exact cause isn’t known, factors that appear to play a role include:
Triggers
Risk factors
Diagnosis
There’s no test to definitively diagnose IBS. A complete medical history, physical exam and tests may be performed to rule out other conditions. After other conditions have been ruled out, one of these sets of diagnostic criteria may be used for IBS:
Treatment
Treatment focuses on relieving symptoms so that you can live as symptom-free as possible. Mild symptoms can be managed by changes in lifestyle and dietary habits:
Based on symptoms, medication may be prescribed:
(With inputs from Unnikrishnan S from Thiruvananthapuram, Kavita Bajeli Datt and Ashish Srivastava from New Delhi)